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You don't say..... I dont mean that in an insulting kind of way but I thought gender dysphoria was already treated as a mental health condition

I think it used to be. About 10-15 years ago that consensus started to wobble, and now nobody knows what's going on any more.

Another redditor has clarified that gender dysphoria itself is not (no longer?) considered a mental health condition. The related effects such as depression etc, however, are.

This is what I don't get about the consensus here. Many mental health conditions are diagnosed based on the discomfort felt by the patient. To wit, this would mean in this case that wanting to be the opposite sex, or believing you are, wouldn't inherently be a mental illness. But... the dysphoria, the discomfort (dysphoria being the opposite of euphoria) is the defining characteristic of a mental illness/ disorder/ whatever.

There are lots of things about the way we all handle trans issues that are contradictory at best

The waters are muddied by a lot of noise from people who are extreme on either side of the argument. Ideally we'd have a good multiyear cohort study of many many different trans individuals from all walks of life, and then medical professionals too, including those who have physically transitioned and those who haven't and don't want to, and those who have and stopped. Would need to be hugely open and transparent and importantly - up for thorough critism and questioning. I've got a reasonable amount of experience in the field personally and professionally and I still could not tell you what I think the 'right' thing is or where the line is drawn.

That would be wonderful. Why isn’t this happening? Or is it happening but it’s not “finished” (produced useful findings) yet?

It's helpful to consider the fact that in the 1950s a gay man in the UK would have experienced similar distress at being attracted to men, since he knew that acting on those instincts would likely get him branded a pervert, possibly criminalised, etc. These are entirely rational fears and none related to being gay, but to society's response to it. I think most of us would agree that in that case it was society which was at fault rather than the gay man, because we now understand being gay is not something you choose, it's something you are. That's why the WHO, DSM, APA etc no longer considers being trans to be a mental illness, but treats the dysphoria engendered by those feelings.

> It's helpful to consider the fact that in the 1950s a gay man in the UK would have experienced similar distress at being attracted to men, since he knew that acting on those instincts would likely get him branded a pervert, possibly criminalised, etc. These are entirely rational fears and none related to being gay, but to society's response to it. This feels very sophistic - that is not the type of mental distress that a trans person 'should' feel at being trans (though they would also be feeling these things).

It follows with how it’s treated because you wouldn’t affirm damaging thoughts. Whether or not you consider that assessment and treatment correct is another story, but that ship has sailed.

That ship may about to be firmly and resolutely dragged back into port on the back of litigation and medical malpractice lawsuits from young adults sterilised as children in the US

Let's be clear: you're not going to find much support, even in the lgbt community, for full blown surgical intervention on children. There is an entire universe of difference between where gender affirming care starts and surgical intervention ends...

I mean so did being gay, obviously there’s something going on in the brain/genetics that causes people to be this way, act mentally different than what is expected, or normal for the average person. Whether or not the effects are detrimental to health is the question, and what the root cause and solution to these issues are. Many people in the LGBTQ community would attribute this to and report that the heavy discrimination they face as being one of the main causes for health issues to arise, therefore the general consensus for a while has been that positive affirmation be a course of treatment while they go through the process of coming to terms with who they are, just like gay people have done in the past. Obviously sexuality and gender are not the same, but they way these groups have been discriminated against and how we create an environment that is positive for their mental well being is analogous. I always say this, and we can look to the past and learn from what has happened to groups that have gone through similar processes in the past while experiencing discrimination for being themselves.

> Many people in the LGBTQ community would attribute this to and report that the heavy discrimination they face as being one of the main causes for health issues to arise, Case in point: suicidal intention/attempts (as a fairly crude metric for mental health) I'm trans people fall incredibly dramatically with things like 'familial support' and of course 'being able to medically transition'. (But seriously supportive environment is huge, some studies show parental support drops it to same level of overall population, particularly in teenagers)

Tbh when I was a teen I thought I was in the wrong body and my husband said the same thing too. We are both in a happy and healthy 13 year marriage, both very happy with who we are and acknowledge that it was definitely just a side-effect of extreme depression and going through teenage bullshit. Obviously not everybody’s like this, but the majority of people I’ve met who have had the same feelings say that it was something that developed in teenage years and dissipated very quickly, and it is a small minority who continued to feel that way and subsequently changed gender after years of therapy.

This is why we have gender therapists who are capable of assessing whether a teenagers dysphoria is related to gender or something else

Yes we do, but the healthcare system in the UK is still very much under funded and heavily flawed and it is not possible in this day and age to get the appropriate care that you need at the level that you need. Especially with the rise in people seeking gender reassignment treatments, I can only imagine how awful it must be as a practitioner to not be able to give adequate time to each patient but still have to prescribe them some so they just throw the cheapest and easiest thing at them and hope that a few hours ( if you’re lucky) of consulting will be enough.

The cheapest and easiest option is to do nothing and delay treatment, which is what they've been encouraged to do

Easiest for who though? Surely if these kids and adults are suffering, they should do SOMETHING. Invest in mental health services and the availability of therapeutic services for example.

Exactly, for a lot of these kids it is literally a life or death situation and in that moment most parents are going to do whatever they can to keep their kid alive. There is a very small portion of people who go back on their decision to transition, but that’s the case with anything. It’s like saying that people shouldn’t do plastic surgery because 20 years down the line they might dislike their boob job. Anything you do to your body is going to have side effects/repercussions but when your child is extremely suicidal and hates what they see in the mirror every day you’re going to do what you can to give them a good life and to keep them alive.

The overwhelming majority of people who transition do not regret the decision.

Thank you for your input :)

I think people do need to treat it more as a mental condition and encourage therapy for a number of years before making the switch because it’s wonderful, that people feel confident and safe enough to come out but on the flipside, my husband‘s youngest brother decided he wanted to present as female when he was about 16, and then a couple of months later, very sheepishly, went back on it, and I think it was more of a case of him not feeling like he belonged, and that was the logical answer. When we were kids if you were weird or different you became a goth, but that isn’t really a thing anymore because it’s not seen as weird, nor do subcultures really exist anymore.

Cases like your brother in law are normal tho. People who try it out and decide it's not for them tend to switch back in very short order. I did the same after a period of questioning my gender and switched back within a week because presenting as male turned out to be intensely uncomfortable Since then I've been incredibly comfortable in my cisgender identity, I'd recommend it to everyone tbh People talk nonstop about how virtually no trans people desist but I see no discussion of this exact way that social transition acts as a filter. It will genuinely give you dysphoria if it's not right for you

I mean from my perspective I have a lot of concerns about young people deciding they want to transition at that age. My understanding is that it is better for them long term if they do transition early, however, I know I wasnt capable of comprehending that situation and consequences of it long term at that age so I think is something we need to have a discussion about as a society

I 100% understand and agree with you, but on the flipside I also have a few friends who transitioned very very young and are very happy with the decision they and their parents made. Unfortunately, this is an extremely nuanced situation and there is never going to be a right or wrong way to handle it and our current healthcare system does not have the means to provide the specialised and individualised care that each child/adolescent/adult needs.

Absolutely. Tbh in this instance I kinda feel sorry for the NHS as they are damned if they do and damned if they dont.

I agree. If one kid ends up regretting it and having a host of related issues going forward after detransitioning, and another doesn’t and is saved from the horror and embarrassment of going through the wrong gender’s puberty, how can you possibly choose a right or wrong? It’s extremely delicate.

There's a trial on this very subject starting

Oh??

I was gonna say, the statement is true no matter how you slice it. If somebody isn’t psychologically comfortable in their body then there’s a mental issue - in at least as much as there’s a disconnect between the body and the mind.

There seems to be an issue with some trans people that they have underlying mental health issues but have convinced themselves it’s *all* down to gender issues and a successful transition will solve their problems and it’s become very politically incorrect to be anything but 100% supportive as well as other issues like the poor state of mental health services and the stigma of detransitioning.

Yeah I can imagine that is big problem and contributing factor. Like you say mental health provisions in this country are virtually nonexistent. I imagine it can be somewhat confusing if you genuinely want to transition but then when that doesn't solve all problems you might start to doubt whether you did or did not want to transition. When the reality may well be that you wanted to transition but there are other things going on

Yes but it's also true that transition has a better success rate on curing depression in transgender people than antidepressants do. It's often a chicken and egg question (is gender dysphoria the reason for your depression or are they unrelated? Hard to tell!) and gender dysphoria compounding existing depression(/etc) if it is underlying (understandably)

The NHS has for a long time been essentially unwilling to concede that anyone, especially minors, _has_ gender dysphoria. They will do and say _anything-comma-anything_ to get you to agree it's something else and go away. For minors this is often quite coercive. "No you're just gay" etc. For adults it can be a Catch-22 situation since if you have _any_ comorbidity like (obviously) depression, ah! that must be **the only** issue! and if you don't, ah! then there **is no** issue requiring action. Bonus points of it's something like autism spectrum that serves as a permanent mark on the medical record that can never be expunged, and therefore they can never be expected to acknowledge a dysphoria. They are required to concede that it exists in the abstract, but it's functionally impossible to get them to admit to instances of it.

I thought it worked quite differently at the controversial and now defunct GIDS clinic.

GIDS is the type example - assessors were actively pressured by management to reject even textbook cases, to come up with spurious excuses to delay "another" year, and in at least one case to get kids to say they wanted to detrans by any means necessary including outright emotional abuse (i.e. the famous "your parents will disown you", "do you really want to be bullied for the rest of your life", etc). Of the tiny minority of children seen by GIDS at all, almost none made it through the gauntlet by design; it was like the DWP: the answer is No, the interview is to provide justification.

Tavistock saw about 3 people a year 

I see. Thank you for the information. Without prying, it sounds like you have personal experience. If so I hope you get, or have got, the diagnosis you need :)

The problem is gender dysphoria is a real thing, but there’s obviously a social contagion aspect to the huge upswing in it recently. And then add a ton of politics on top of all that and it’s just a mess.

Like Autisum and previously homosexuality, I don't think their has been an up tick in dysphoria cases, what has happened is more people have been able to put a lable to it. 

We were under section 28 when I started school, what you're saying is not different to what people said at the time. as a gay man with a lot of trans friends, it seems like nobody has learned anything since then.

Yeah absolutely. The problem is, the way I see it, is this is something that society as a whole needs to have an adult conversation about, hopefully realising it's not a big issue and that these people deserve compassion and help not someone screaming about men in skirts in women's toilets but we are unlikely to ever get that conversation and ultimate resolution. It must making transitioning even harder in this climate as your personal issues just become a part of some nebulous culture war bs

Social contagion is a very strong phrase. You're insinuating that being trans is contagious, can you at least see the parallel between what you've just said and the discussions we had about gay people 20 years ago, or racial mixing 80 years ago?

Let's not forget the "social contagion" of being left handed! That's exploded since we stopped punishing children who dared to try and write with their left hand.

You get shot for saying it, though. I mean psychologically it couldn't be more clear: you mentally believe or think that you may be in the wrong physical body. It is a direct analogy with other mental health issues which, for instance, believe that they have super powers, are God, or that there is a conspiracy against them. Yet around 10-15 years ago it became acknowledged as a truth. Yet we still lock up and forcibly inject the others with antipsychotics because of their own beliefs and feelings, yet do surgery and hormone blockers on the former group...

Actual psychiatrists are pretty well able to distinguish between gender dysphoria and psychosis. Psychotic episodes tend to be acute, with the paired delusions lasting through the florid psychotic phase and then subsiding through the prodromal phase. These phases occur even without medical intervention. I'm sure you're very passionate about this issue, but from your comment I'm not sure you know enough about either gender dysphoria or psychosis to draw an effective comparison. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10324839/

well.. yes? for a person to want to transition, 9 times out of 10 they have severe issues with their body and as a result of this + societal stigma, of course they’ll have mental health issues. there’s various studies on how transitioning increases mental health in adults etc the way some other comments are talking about helping dysphoria via actually fixing something within the brain (as dysphoria is the symptom, not cause) are very uncomfortably written imo. i don’t believe transitioning is a ‘primitive’ form of healthcare, it is by far and away the best avenue for trans people to take. (token disclaimer: i do not believe children should be allowed to medically transition)

are kids actually medically transitioning? I've always assumed it's a dragged out boring moral panic because of the numerous layers of therapy / medical professionals you need to jump through to actually get surgery and ofc not all trans ppl feel the need to medically transition, do people inappropriately conflate gender affirming care (i.e. hormone replacement) to be on the same level as bottom surgery?

Its squishy and partly is based on where you draw the line of "kids", and where you draw the line of medical transition, as altering your clothes is technically part of a medical transition and 18 is adulthood but 16 year olds can move out, join the army and have sex. [In the uk an under 18 has to see a specialist child clinic to have accsess to any medical transition, but this means seeing a team involving all of the following: A clinical psychologist, a child psychotherapist, a child and adolescent psychiatrist, a family therapist, a GP and a social worker.](https://www.nhs.uk/conditions/gender-dysphoria/treatment/) Then after that you have to be 16 MINIMUM based on individual assesment for hormones either with parent involvment and aproval OR divorced from parent involvment via Gillick competence to show a 16 or 17 year old is able to consent to medical treatment (same thing you have to show to get a surgery your parents dont want but is medically reasonable, ive seen it happen with parents who were scared of their kid getting surgery for Crohns disease). Gender surgery you gotta be 18 in every possible case. Worth noting this is a process but as I mentioned 16 is the age of consent and a child can just move out at 16 and start living alone and get your first motor vehicle license n stuff anyway. I know an (unrelated, non trans) family member who disaosiated from their parents and started living alone with council support at 16 cos their mum was awful. There USED to be a "middle option" of hormone blockers as a non transition option for under 18s/children but that was ended unilaterily in the uk for specifically trans cases (hormone blockers still agreed as safe and reasonable for other conditions). Normally in most cases even involving a child gender clinic you can only start hormonally transitioning either at 18 with a willing medical practitioner OR after multiple years of starting the process with an nhs adult gender clinic if there is one operating in your area, though most have additional years of backlog. The Cass Report (that this thread is about) explicitly states that 25 should be drawn as a minimum line for "major life decisions" and effectivly the true end of childhood, which seems a bit barmey as a redefinition and a good way to piss off every under 25 when we are charging em taxes already lol.

NGL this is one of the most respectful and level-headed discussions on this issue I have ever witnessed online Edit: this post, not the article lol

Those who wish to transition clearly have a major misalignment between their minds and their bodies. Whether or not you view this as a mental illness seems largely a philosophical/moral issue.  Either way we do not have the ability to alter trans people's minds to bring them in alignment with their bodies. Even if we did this would seem a profoundly invasive thing to do.  I certainly would never consent to such a thing though luckily such things have never been an issue for me.  In Contrast we've had the ability to surgically align trans people's bodies with their minds for some time. Why are so many people so preoccupied with opposing the only means we have of mitigating the suffering of a tiny number of people who wish to transition?

>we do not have the ability to alter trans people's minds to bring them in alignment with their bodies. In those exact words, no: However it is worthy of consideration that some people are known to experience a sense of gender dysphoria as a symptom of other issues, while not actually being trans. It can be observed sometimes with people who actually have other problems relating to identity, sexuality, existential angst, or other conditions, but then when they either overcome those issues or examine the gender identity thing a bit more they realise that's not what they really want (to transition). In my personal opinion, I suspect this is usually the case with "detransitioners"; that they were never really transgender to begin with and were simply misdiagnosed. It should be noted as an aside that I am categorically **not** denying that real trans people exist, nor do I support the view that transitioning is never an effective and ethical treatment, by the way. The issue of course is two-fold here. Firstly, while it is often the case that the people described above might benefit from therapy exploring and deconstructing their feelings of dysphoria, this may not be healthy for *actually* trans people and potentially crosses a line into "conversion therapy" for them. Secondly, that trying to figure out whether someone is trans, is experiencing dysphoria as a symptom of unrelated issues, or is simply exploring their gender identity and sexuality in novel ways and is a bit confused for now, is no doubt quite difficult and probably quite subjective. If a person feels dysphoria, then they feel that sense of being "wrong" regardless of whether they are trans or not, so it must be questioned in practical terms if there are reliable psychiatric methods for determining the diagnosis and best treatment.

> In Contrast we've had the ability to surgically align trans people's bodies with their minds for some time. Why are so many people so preoccupied with opposing the only means we have of mitigating the suffering of a tiny number of people who wish to transition? I don't think many people are. If consenting adults want to do that to themselves it's generally regarded as up to them, I haven't even seen much opposition to the state paying for it. People may think it's unwise, but it's up to the person.

Exactly, I’ve personally no objection at all to adults undergoing this surgery. It’s when we’re talking about prescribing drugs to block natural development or surgical intervention in kids that I get extremely uncomfortable. I just have a hard time believing an 11 year old can fully understand how they feel, and the long term implications of any procedures, in order to give truly informed consent.

It's complicated, but as someone who transitioned as an adult , it wasn't very fun going puberty, it genuinely was pure mental anguish. The issue is that puberty isn't a neutral act for those of us who have to suffer and that's not even accounting for the expensive extra surgeries (and the risks associated with then ) you will require because of going through puberty or fact your less likely to pass because of it ( which can its own set of issues). But if we could avoid the above , which we can then I think we have a duty to at least consider it. Your talking about whether an 11 year old can give informed consent but that's why we let parents make those decisions. But I can say that 11 I had very obvious symptoms of gender dysphoria. In retrospect for me a world where I got puberty blockers would have been a much better existence for me. Though I wouldn't have needed them till i was 13/14 anyways, even getting them 16 would have made huge difference for me. I do hope in the long term that at least when it comes to adolescent gender care that we will set an improvement in both diagnosis criteria and treatment. If we can more accurately diagnosis it then it's makes giving treatment less risky and more effective.

Our politicians seem against it.

Against what? We have a Conservative government with a large majority, we've had Conservative governments for 9 years, including the period when they were allied with a much more conservative party (the DUP). At no point have they taken any steps to ban it or even stop paying for it. When are they going to do anything about this practice they're supposedly against? They're very likely to be replaced very soon by a more pro-LGBT party.

No they don’t. I’m sure it’s happened at some point, but I can’t think of a single politician who wants to band gender reassignment surgery. Even in the US, the bat shit insane politicians only talk about sports, women’s toilets/changing rooms and children. None say the surgery itself should be illegal (for adults).

[Many States Are Trying to Restrict Gender Treatments for Adults, Too ](https://www.nytimes.com/2023/04/22/health/transgender-adults-treatment-bans.html) [Ohio is poised to become 2nd state to restrict transgender health care for adults](https://www.pbs.org/newshour/politics/ohio-is-poised-to-become-2nd-state-to-restrict-transgender-health-care-for-adults) >Even in the US, the bat shit insane politicians only talk about sports, women’s toilets/changing rooms and children. None say the surgery itself should be illegal (for adults). They are working up to it

Absolutely and what harm does someone transitioning do to anyone else? The amount of people who want to oppose individuals who have made an obviously difficult decision to do something that will make them more happy is astounding. Trans people aren’t harming anyone else in their decision to change their gender so why not let them get on with it

Because ideally they need to start transitioning as a child, by taking hormones and puberty blockers that cause permanent sexual dysfunction. Combine this with a situation where they're socially encouraged to do it, where teachers and doctors lose their career if they dare object to it, you've got a situation where people kids are being encouraged to choose sterilisation. So that kinda gets parents' backs up.

>Why are so many people so preoccupied with opposing the only means we have of mitigating the suffering of a tiny number of people who wish to transition? On a basic level, yes, adults can do more or less what they want with their bodies. Of course, there is always an uncomfortable question who pays for this, but let's set this aside. Much bigger problems are actively trying to *change society* in certain ways, which people have every right to oppose, *and* potentially interfering with development of children. Forcing "gender neutral" ("inclusive") language (which doesn't even make sense in most foreign languages), "pronouns" (it's natural and expected to address a transgender individual according to his or new chosen gender, but "pronouns" go much farther), female sports, same-gender spaces, and so on are real concerns (even if at times exaggerated) which shouldn't be dismissed on a ground that "we just help some people to feel better". FWIW, sex reassignment surgeries, today known as "gender affirming surgeries", existed for many decades, since 70ties if not before. Acronym "LGBT" exists since late 80-ties or early 90-ties, always, since its inception, with "T". Dana International won Eurovision in 1998. None of that is even remotely new. Yet, today's "trans culture" or "gender ideology" as some call it *is* very much new (and not even known much outside of English-speaking world), and I think people mostly oppose *than* and not "mitigating the suffering" as you make it sound.

Inclusive language hurts absolutely nobody, and is pretty easy to keep track of. I don’t see it as particularly difficult to account for small minorities or fringe cases in certain specific scenarios. This isn’t impossible for foreign languages either, who have come up with their own terms for such things in the past and will continue to do so as and when they please. Literally everyone uses pronouns, and have done so for most of recorded human history. Nothing has changed about their usage in common society whatsoever. There are barely any trans femme athletes and the horror stories of supposed trans dominance in women’s sports are heavily exaggerated. I’m sure it’s happened, and worries about fairness are warranted to an extent, but some would have you believe that a legion of transgender invaders has conquered every avenue of women’s sports when that isn’t true. It’s certainly not true at a childhood sport level, or for trans women who transitioned in their youths. Trans people have been using same-gender spaces for decades without an apocalyptic surge if danger to cis women. “Gender Ideology” is a buzz term created by anti-trans proponents to demonise the exact practices that trans people have always been *safely* following, to no one’s detriment. But now that people are making an effort to include us more visibly in society suddenly it’s a new and scary thing that we… want to keep living as we always have? That we want to participate in society and strive for excellence? That we want better lives for our young brothers and sisters than we had?

You're basically arguing that these concerns are unwarranted and/or exaggerated, and you may be right (I agree with some points you made but disagree with others), but that's not the issue here. The issue is, this goes far beyond what some people want to do with their bodies. Yes, in a rational society a man should have a right to say "from now on I identify as woman, please address me accordingly", because good or bad, it's her decision and she shouldn't be discriminated against because of this. However, a biological male *can't* just decide "from now on I'll have access to women-only spaces", because it's *not* his, or her, decision. That's the gist of the problem as I see it, while individual freedoms must be respected, some people feel that there are certain changes being pushed by "activists" without sufficient public debate under the guise of "trans rights" or "inclusivity", and even if we agree that these changes are not especially taxing or terrible, that's not how changes should happen.

The problem with your saying that biological males can't access female-only spaces if they identify as a woman is it proves that society doesn't perceive them as women. Lip service will be paid for things that don't really matter like pronouns etc. but excluding them from women's sport or spaces, etc. proves that they are still viewed as not women.

Isn't that likely the case though? Most people will be polite and address them as they want to be addressed but most people understand sex as being immutable and so do not believe that they have changed sex.

Exactly. The entirety of society has to play along, with conviction too.

They are not viewed as *biological* women because they aren’t, this might not matter in some situations but could be very relevant in others.

Yes it does hurt people. The NHS has got into a right mess and lots to f service users don't have the understanding to wade through obscure language in sessions like antenatal classes.

It doesn't *hurt* people, but compelling people to use language that they believe is inaccurate and suggests a certain belief about gender upsets people. If people want to be nice, that's great, but there should be any compulsion or threat in it. People's views should be respected. What's new about pronouns are requirements that people advertise what their pronouns are and the use of the "they/them" pronoun to refer to known people. Literally nobody thinks transwomen have conquered every avenue of women's sports. People object to it happening *at all* because they feel for the women who get beat.

If they are undergoing medical procedures with long lasting, wide ranging consequences, they needs a solid grounding in evidence (both cost effectiveness and medical benefit) before it can be provided by the NHS. Just like any other condition. Its not a simple matter, and it gets even more complicated when you chuck in the fact that children are seeking treatment for this condition, they dont have the ability to consent nor understand the consequences. With regards to why people are so preoccupied by it...probably just social media (and traditional media) rage baiting, turning it into a politicised issue etc just like everything else

We absolutely have the ability to change it through therapy for the vast majority of people with gender dysphoria. It is almost always linked to trauma. The Venn Diagram of people with gender dysphoric thoughts and Trauma is massive. The other elephant in the room is autism. The autistic kids who are treated as trans are not trans, they're autistic. Discomfort and pseudo gender dysphoria with their sexuality/etc is the cornerstone of autism. And perversely invasive? What like every other psychological issue that is adjusted with therapy? People with debilitating personality disorders, trauma, PTSD, even schizophrenia and Bipolar can be improved with therapy. Those are all invasive, by their very nature.

>The autistic kids who are treated as trans are not trans, they're autistic. Those two are not mutually exclusive. Sure, there might be some cases of autism being misdiagnosed as GD, but they can also coexist in the same person without necessarily being connected.

Ok, using a definitive there was a bit inaccurate. However, given almost all of the detransitioning cases have been autistic people and having an autistic son myself, I do get very defensive. Theyre a population group who are particularly susceptible to the trans activism and gay kids and autistic kids are disproportionately harmed by it.

I mean, I hope as you have an autistic son yourself you would seriously consider his opinions and views around his life might be the valid and correct ones.  Certainly you’ll have seen examples of when that wasn’t the case. My own experiences as an autistic son is that not having adults take your own internal life and mind seriously was an incredibly damaging thing that has still left serious scars.  I’m also pretty confident my own sense of gender identity isn’t socially imposed, although it also matches up with my outside sex and is not especially interesting. The idea that it might not be and people wouldn’t listen on the base grounds of compassion sounds absolutely awful to me.  I was still wrong about a lot of things? I was also right about a lot of them. The idea that sometimes a child is right – and sometimes an autistic person is right – has to at least be considered. 

Of course it should be considered and explored! Nothing should be dismissed or ignored. The issue is that it needs to be treated and considered seriously and with awareness that these thoughts are more likely to be coming from other places. That doesn't mean it isn't coming from a "transgender" place or dysphoric place, but that the chances of it being that opposed to other explanations is a lot less likely. As adults, part of our role in society is protecting youth against itself at times. Most of us in our 40s have enough self reflection to know how stupid, idiotic and reckless we were as teenagers. Being so towards our own gender/surgery/etc is terrifying because there are going to be losses. I have worked with both boys and girls who are now infertile after detransitioning, both because of being on puberty blockers for too long, or having the surgery. I have lost patients to suicide as a result. These are not without impact on both sides. I think transgender advocates think that just fully supporting this movement means that the only things that happen is transgender kids get full acceptance and the care they need. If that was the case I'd be the first to sign up and advocate. However, 20 years working in the field, I can safely say there will be costs that people will look back on and say "was it worth it?". Maybe in the future there will be technology or tests that can 100% tell a trans person and then this becomes irrelevent. We're a very, very far away from.that place now.

But if it is the case that the number of people who happily transition is very high, then the opposite is also true. It would be more likely that an autistic person would detransition— but if that number is still low relative to the number who are much happier as a result, then the autistic people who’d be in the second category suddenly have a very raw deal. You would want greater safeguards for autistic people? But those safeguards themselves are going to cause pain when they go wrong. This is the notorious “bad things happen if we are overzealous, and bad things happen if we are not” problem, I guess. But I would say that I don’t think the stance of seeing teenagers as inherently reckless and stupid in medical matters is likely to lead to the least horrific outcome. Certainly my own life has been much worse as a result of that assumption; like a lot of millennials the idea that adults knew more about depression and ADHD than the youth did has had some dire consequences. I don’t believe we can protect with an assumption of recklessness. I don’t believe that as a teenager I was the reckless one.

Sure, but since moving to Australia who are much more likely to prescribe ADHD medications, a good 1/4 of hospital avoidance and admissions arr mental health reactions to ADHD meds. I never saw this in 18 years in the UK. As for detransitioning, let's just say that the numbers often reported are wildly inaccurate. Where I worked in North Essex in the UK we kept local numbers and over the past 7 years we kept records, the detransition rate had risen from around 2% to around 30%. The evidence of this is very poorly collected and there is a LOT of pushback around any data is collected. Let's just say my NHS Trust did not publicly disclose its data either as it did not want to fact the public backlash and examination from places like Stonewall etc. It's just not worth it, in particular because there were things that the Trust was struggling with and it didn't want the attention. I worked closely with the Tavistock Centre as well and they had data that showed detransitioning had increased substantially and that the groups were most affected were autistic and sexual abuse victims. I hope.in time we can have an open snd honest discussion as well as better collected date. Unfortunately the data that is collected is either by TRA or by Far Right Conservatives. The moderate middle is shot from side.

>However, given almost all of the detransitioning cases have been autistic people and having an autistic son myself, I do get very defensive. And being a person with autism myself, I get a bit defensive when people generalise us.

> we do not have the ability to alter trans people's minds to bring them in alignment with their bodies. Actually we do have an array of treatments for body dysmorphic disorder, which to me it is obvious transgenderism is. Unfortunately we cannot research the topic without activists and politicians involving themselves, so surgery remains the only treatment to people. I think in the future people will look back with horror at the fact we subject vulnerable patients to highly invasive and brutal cosmetic surgeries because we were too emotional and frightened to simply do some research first. The downvotes this comment will inevitably receive (and probably ban from the mods) will prove my point completely.

Okay, and what if the research [has](https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2333525) [been](https://link.springer.com/article/10.1007/s13178-019-00394-0) [done?](https://www.nature.com/articles/s41562-023-01605-w) and suggests that hormonal and surgical interventions have positive outcomes in mental health changes. This contributes to the [scientific consensus ](https://news.cornell.edu/stories/2018/04/analysis-finds-strong-consensus-effectiveness-gender-transition-treatment) that these forms of care are efficacious. Would that be enough research for you or does it have to align with your beliefs?

Sounds like we don't need to research this because you're right and everyone else is wrong? You're not stuck in traffic, you are traffic.

I'm saying that we need to research the topic and this is your reply. I think you are reacting emotionally not rationally, which is exactly my point.

What I'm saying is that you've presented a closed minded viewpoint, unbalanced and incongruent with your call for more scientific research.

>closed minded viewpoint, unbalanced How so?

Getting downvoted doesn't prove you right.

Being downvoted for saying we need to do more research is a clear sign that people are not thinking rationally, which is my point.

Let's play loud part quiet part! Loud part: We should do more research into why people are transgender Quiet part: Because then we could find a way to 'cure' them because I don't think transgender people should exist. See why people have an issue with that?

>I think in the future people will look back with horror at the fact we subject vulnerable patients to highly invasive and brutal cosmetic surgeries because we were too emotional and frightened to simply do some research first. Modern research into gender transition began in the 1920s. Current treatments were settled on by doctors that observed that the treatments then did not work, and that cross-sex hormones and surgery did. For some reason when talking about transgender issues people seem to forget that Western medical establishments used to be against the idea of transition and treated it like a mental issue which they attempted to treat with therapy, same-sex hormones, anti-psychotics, electroshock, etc. all to significantly less efficacy than the gender affirming transition treatment that exists today. There seems to be an inexplicable yet extremely pervasive belief out that there that Western doctors settled on gender transition for apparently no reason and there is a secret much better approach that would certainly work if they just tried it. But there isn't. It is almost guaranteed that whatever super obvious treatment you think that doctors just haven't tried or is being unfairly suppressed has already been tried and failed. Again, we have been at this for over 100 years at this point, during which time there were no shortage of doctors in the US and UK that thought trans people were mentally ill and just needed knocked straight. Do you genuinely think that none of them, at no point in time, stumbled upon the thing that is "obvious" to a random Reddit commenter?

We did not know nearly as much about the brain 10 years ago as we do today, never mind 100 years ago. You are suggesting that because these treatments failed in the past we should concentrate on treatments that have shown to be effective since then, but this biases our current research away from potentially much more effective treatments.

Do you have any examples of studies that have been pulled or cancelled in anyway as a result of activists and politicians?

I remember that when I was sixteen, I used to cry myself to sleep at night, wishing and praying that I would wake up as a girl the next morning. I never told anybody about it because when I was sixteen, trans issues and trans people just weren't things that people spoke about. In fact LGBTQ issues in general were hush-hush, and people stayed in the closet. Since leaving secondary school, several of my friends have come out as gay. When we were at school together, I had no idea. Hell, only one of my ex-girlfriends identifies as straight now. Two of them are lesbians, and one is now a man. (I'm not sure if he's my ex-boyfriend now, but I'm happy for him, and proud of him for choosing to live life on his terms.) But what does that say about me? All of my relationships as a teenager appeared heterosexual at the time, but looking back on them, there's now this context of queerness and I wonder if I play a bigger role in that than it looks on the surface. But back to the point, what does it mean to be a man? How does it feel to be a man? I honestly don't know if I could tell you. When I was younger, I was bullied for not being as masculine as my peers. But I've never really felt masculine, even as a child. When I was asked to imagine myself in the future, future-me was always a woman, and I never really knew why. I didn't know any trans people, I wasn't exposed to trans groups online or anything. It was just this innate feeling of "that is how I'm supposed to be." I'm in my thirties now. A mess of anxiety and depression, and every day, I think about what my life would be like if I had told my parents how I felt at sixteen. Would I have had therapy? Would a doctor have told me that I was transgender? Would I have transitioned? Would I be Megan, or Emily, or Bethany? Would I be happy? I'm in my thirties, and I haven't gone down that path. I find happiness in other things. I have a daughter, and I love her more than anything else in the world. If I had transitioned when I was younger, I would never have had her. And I sometimes think, what if I just let that part of myself out, just once? What if I tried crossdressing or something. Would I then decide that I needed to transition? Who else would that impact? I'm certain that it would blow up my family life. Sometimes, it feels like I'm holding a grenade, never really sure if or when it's going to detonate. So I try not to think about it. Because, maybe I already know the answer, and accepting that would be really difficult, and if I don't acknowledge it, then I can keep my life as it is. Because I know what this is, it's safe and comfortable. And if it's difficult for me to think it through and deal with, no fucking wonder that a kid would have mental health issues alongside it. Thank you for listening to my TED Talk. I'll be finding my way back to Narnia soon.

A warning. You'll most likely regret more the longer you let that go unaddressed. Whatever conclusion you reach after some thought and self-examination, it's most likely better than refusing to have that conversation with yourself in the first place, or denying what you actually want.

> You'll most likely regret more the longer you let that go unaddressed How old are you as you say this? I am not in any way transgender, but I found as I've gotten older, I've stopped caring so much about my identity and where i fit in the world, because I'm just gonna get on with it as best I can either way. I've got my work and career to worry about, the hobbies I do, my social circle, etc. i think it's a young person's game to introspect constantly. If you leave it, eventually you'll just shrug and get on with your life, as OP appears to have done.

Old enough to know I'd have been a damn sight better off if I hadn't put myself off. Having a career and friends is fine....But it's comparing two different things. Like, if I shoot you in the foot, you might still be happy at your programming job, but you'd probably feel better without that new hole, right? That's what it's like. You can feel good in some respects, but that doesn't mean *that* pain goes away. You can do all kinds of things, but if you don't treat it it's not going to get any better. Of course, I'm not telling that person what they should do. If they think they have a bullet in their foot, they can choose to check or not, or check, find one, and just put a plaster on it and hope it goes away, put a sock on and let it be "out of sight, out of mind". That's their business. My point is that in my experience, eventually you get sick of limping everywhere, and by that time you've fucked up your back from the shitty posture and it's that much harder to get well again.

This article doesn’t really tell us a lot/the key findings of the report A) trans kids often have some mental health issue like depression B) if you socially transition at a young age you’re likely to remain transitioned….and it isn’t ‘resolved’ in another way?

They don't like printing the answer to B because it says what the government/NHS don't want, which is: yes. Children who socially transition are _so overwhelmingly_ likely to remain trans that the margin of error (could not contact + "no" because of social rejection) is bigger than the concrete "no" group. (It's about 3%)

From what I remember about the Tavistock debacle, there was a lot of concern about lack of good data on all aspects of treatment. The argument was that we wouldn’t treat adults on such an unproven, speculative basis, so why do it to children? Another issue was not being holistic. The argument was that children at the gender clinic should have been referred to child psychiatrists and not to psychiatrists specialising in gender dysphoria with no experience of treating children. It sounds as though this review is affirming that approach. I certainly agree with treating the whole child. The problem is that outcomes could end up depending on the medical practitioners’ attitudes to transitioning not on the needs and wants of the child concerned.

I suppose the biggest issue with trans people is we really don't understand what is going on there. There are lots of opinions, lots of views, lots of thoughts, but very little data in the way of understanding why someone who was born as one sex feels they were born with the wrong genetics, which makes trying to provide solutions risky.

I wish people understood this as "so we need to talk to the people who are like this and those who work with them to understand what they need" rather than just "we don't know perfectly so everyone should be able to just project whatever their current problem with society is onto them and demand we treat them based on edit:our assumptions rather than based on what works so far"

This is the issue as I see it. Its hard to discuss this topic without receiving significant backlash, which I don't really understand. If you a born in the body of a man, but your mind is telling you that you should be female, something has clearly gone wrong physiologically. We don't understand why this is yet, however denying any attempts at research and treatment are counterproductive. Currently the treatment is to perform surgery and hormone treatment on the body, which is primitive at best and treats the symptom rather than the cause. Treating the brain (which I suspect is the route to resolving gender dysphoria) is unfortunately far more complex.

Given strong co-morbidity with ADHD/Autism and the very high rates of non-hetrosexual (Roughly 1/3 each Hetro/Homo/Bi) trans people along with studies on gendered brain scans it's most likely either genetic or part of development during pregnancy. It is unlikely that we could come up with a neurosurgical solution, or that if we did have one that it would be easier than our current approach. Even before we consider the ethical implications of messing with people's brains to change their identities. Realistically, our best treatment is liable to remain transition.

Yeah this line of reasoning gets into Phineas Gage territory too much for my liking, how much neurological intervention can a person undergo before they’re effectively a different person altogether?

That’s quite a leap. You’ve made the sweeping statement that ADHD/Autism and non-heterosexuality are genetic or pregnancy-related - none of which is anywhere near proven. You’ve then decided that the correlation between those features and gender dysphoria means that they must have the same (completely unproven) cause. There’s nothing in what you’ve said that makes any suggestion of whether the best treatment is physics or psychological.

ADHD being primarily genetic is established science: > It has been known for decades that ADHD is familial and highly heritable (5), with heritability estimates in the range of 60%–90%. Twin studies have shown a strong genetic overlap with other child psychopathology, most prominently with behavioral problems, such as conduct disorder (6). Indeed, ADHD was long considered primarily an externalizing or behavioral problem (7). However, more recent genetic studies have highlighted its neurodevelopmental nature (8), and these findings have added to clinical arguments that ADHD behaves as a neurodevelopmental disorder. ADHD, like autism spectrum disorder (ASD) and intellectual disability as well as other childhood neurodevelopmental disorders, typically has an early onset, tends to show a steady clinical course rather than one that is remitting and relapsing, and is commonly accompanied by early neurocognitive deficits (8). https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18040383

>implications of messing with people's brains to change their identities. But manipulating their physical body is somehow ok? I concede it's a moot point as we're nowhere near being able to offer neurological solutions, but fixing the cause is somehow worse than treating the symptom?

The brain is a lot more complicated than other aspects of your body, and it can be argued that changing the brain could be actually changing that person's identity as a whole

I'm not being funny....but surely the point of transitioning physically is to change their identity as a whole.

Well no, the point of transitioning is to have the body match the supposed identity, not the identity changed to match the body It's certainly an interesting debate and why for instance most people (at least with the slightly more socially functionally cases) have moved away from seeing Autism as a disease that needs to be cured, because it could be argued that its just a different way of thinking and that to cure that would change who that person fundamentally was

Is your entire identity male/female? That's my gender identity, but my identity as a whole includes my personality, which hasn't changed much whilst transitioning

If you think that, you've completely misunderstood transitioning. The point is to bring the body in-line with who trans people see themselves as. To match their identity. Not to change their identity by changing the body.

Robert Sapolsky the neuroendocrinologist said something along the lines of ‘if the brain and the genitals say two different things—-I’ll side with the brain’ Edit: here’s a bit https://youtu.be/8QScpDGqwsQ?si=XESPtN3_oOmKx2j0 Here is a bigger video all about ‘brain gender’ https://youtu.be/-nsQDX_OHNE?si=Htj2XMC5OaiF-RI7

> But manipulating their physical body is somehow ok? Yes. We don't understand what combination of genes, hormones and neurochemicals leads to someone being trans, in much the same way we don't know precisely what leads to homosexuality. It will be centuries before we completely map these things. Altering the body to conform to the trans person's chemical/genetic predispositions is thus in most cases the best option.

We don't even know what leads to heterosexuality, we just understand that it's evolutionarily beneficial for the species.

You sort of *are* your brain whereas you just live in your body. I'd feel a lot more uncomfortable about getting a lobotomy than getting an amputation.

You're correct for our current point in time. The brain is just too complex to treat effectively and safely with our current medical knowledge. However if you look back 100 years and see the advancements made, it's not unreasonable to suggest that we will eventually aquire the ability to treat neurological disorders effectively which we can only imagine right now

True, but with upcoming technology on stem cell organ cloning, DNA editing and enhancing surgical techniques it is probable that the best treatment will remain transitioning. Just a more total form of it. If you can accurately identify trans kids during childhood, you can have them on puberty blockers/hormones so they don't go through their natal puberty and then if replacement cloned genitals are available they could transition to being 100% indistinguishable from their cis counterparts. I think this is a more likely course of action than a completely unknown at this point neuro treatment.

We are comfortably a few hundred years away from even being able to answer that in any meaningful way. Also, there is plenty of research that shows XY vs XX expression of proteins etc is sufficiently different to require much more research. Basic biology is notably different in males and females. Source: doing a PhD on this subject.

"Treating the mind" is also much more fraught with ethical issues, as you are talking about changing someone's sense of self. That is a much more significant change to who someone is than modifying their body.

It's scary how many cis people think that molesting my brain to turn me into a completely different person is a better solution than letting me be myself just because that would align more closely with what they think I should be like.

That's just about the least charitable reading of the point, no?

I can tell you that HRT has improved my life greatly, and the data suggests the same for most trans people. However, it’s still the case that trans people suffer from more mental health issues. A large reason is a lack of acceptance from friends and family.

That's great, and there has been progress made with the likes of HRT, but it's not really my point. My point is that trans people were born with gender dysphoria, we don't know why this is or how to treat it. But if a treatment was available which could theoretically identifiy it the womb, and say a medication could then be given which would resolve the gender dysphoria then that would be the way that it would ultimately be resolved.

If we could remove the suffering but not the difference in general that'd work, otherwise this kinda goes into "should we remove all differences from humans to make them all the same so they have nothing to discriminate against each other over" territory.

Why isn’t the solution ever ‘maybe our ideas of gender are intrinsically harmful to millions of people and we should try to end the gender binary’? It’s bizarre to me that people are considering medicating away a dysphoria which begins so often in societal expectations and issues. While there may be a biological basis for gender dysphoria it seems insane that people don’t consider that perhaps our ideas of gender itself is the problem.

We know what the correct treatment is: fix the hormone profile so the brain is happy. It's surprisingly easy. You have an extremely high moral _and logical_ bar to clear with the argument that you should change the brain to fit the hormone profile instead. Starting with what on earth purpose does this serve? Literally. We have a solution that works. The principal obstacle is ideologues and lack of social acceptance that it does/should be allowed to work, not the solution itself. Get rid of the bullies instead and you're left with a non-issue.

Except we know this isn't true. There's a reason the issue isn't done and dusted. And it isn't just down to society not accepting individuals and we know this as a fact, hence the desire to find actual solutions to the problem rather than accepting that we have solved it.

> we don't know why this is or how to treat it. But we do know how to treat it. At the moment the best treatments we have, which are pretty effective at improving things, are medical and social transitioning.

Dude, gender is a social construct and the vast majority of gender dysphoria is created by the fact that society is so heavily bias towards binary gender roles. Imagine a world in which your genitals don't have a role to play in whether or not your opinions are taken seriously, or if people automatically assume your intelligence, or whether it's even legal to do things the other 50% of the population can do without an issue. A world in which your genitals don't govern if you can exit your house with makeup on and not experience prejudices, ridicule, physical or sexual harm, or even death. You mention it's not something we are really allowed to talk about... Which I do agree isn't right. But talking about trans-ness like it's a birth defect also is NOT the way to go about it. And leans heavily towards a eugenics way of thinking. ... Autistic people suffer from greater mental health issues, women have a higher chance for mental health issues, black people in the UK are more likely to have mental health issues. Its almost like: - when you're whole society treats you like shit - people in the world kills, injures, or rapes you or your peers. - your society ignores a growing inequality pushing your peers and/or yourself into increasingly uncertain or dangerous situations - your society ignores your human experiences and doesn't listen to you - your society ignores you exist but at the same time uses hatred and ignorance of you for political power - your society makes the things you need to live very hard to get, a moral panic, or straight up illegal it causes them extreme mental anguish!!!!! Who'd have thought! Crazy! I am trans, and I can tell you first hand that the hardest part I've found is ABSOLUTELY the vicious bigotry, and heavy antitrans legislation - experienced on every level... personal, communal, nationally, and internationally.

>Dude, gender is a social construct and the vast majority of gender dysphoria is created by the fact that society is so heavily bias towards binary gender roles. What do you have to back this up? Gender dysphoria *is* about brain/body dismatch, clinically speaking, hence why physical transitioning is used to alleviate it. I'm *also* trans, and can tell you dysphoria was worse than anything else, and physical transitioning is a miracle. And I've never understood or cared for gender roles etc. I'm the same person now, but with masssovely less mental problems. Being trans is just something some people are born with. Also, gender roles and gender expression are social constructs, but: "The 2012 book Introduction to Behavioral Science in Medicine says that with exceptions, "Gender identity develops surprisingly rapidly in the early childhood years, and in the majority of instances appears to become at least partially irreversible by the age of 3 or 4".[12][13] The Endocrine Society has stated "Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity."[14]"

I mean I'm trans and the hardest part I've found is absolutely having a body of the opposite sex, and the vast majority of my dysphoria comes from having a body of the opposite sex. It is ironic that you're talking about what they're saying leaning towards genetics, but talking about transness like it's just some social construct about how much it sucks to have to wear makeup is swinging towards the "it's all in their heads approach".

This is where I get stuck, though. Nobody is pulling down people’s pants to check if they are allowed to wear make-up or a dress. And if they were, having M2F gender surgery wouldn’t change anything, because the result of that surgery does not look like regular female genitalia. (The penis head is still present! They still pee out of it!) What does determine if someone is “allowed” to wear those things is how they look in them. Yet the majority of trans people never manage to “pass” as the opposite gender. Those who do are the rare exceptions in the trans community because they suffer so much less. So if “changing gender” in that sense won’t mean you’re treated better.. and it won’t actually make your body match the opposite sex’s.. then why does anyone do it? I mean, it’s not like they shouldn’t be free to if they want to, but they should really know what they’re getting into. The good news is that inside trans support groups and services they do warn you about this stuff and make it clear exactly what you’re getting into. The bad news is that outside of those groups, and especially in the public image of being trans, they don’t - and in fact mentioning it is seen as an attack on trans people. I know that “asking questions” is often used as a rejection of transsexuality as a whole, and so that community has become reticent to engage in it. (For example, for m2f, “Do you really want to have periods?” If the answer is no they aren’t a woman because having periods is part of being a cis woman. If the answer is yes they aren’t a woman because no cis woman _wants_ to have periods.) But is there a danger that people, or children/teens, are buying in too heavily to the public positive image of being trans and developing core desires which can’t come true? I don’t know, but it’s worth checking, and it’s dangerous if we can’t research this stuff properly because bigots have poisoned the community so heavily.

That's basically just eugenics, my dude. We figured out that's bad about 85 years ago and then had a big war about it.

As someone with a genetic condition that has ruined my life I wish we had gene editing to solve conditions before birth, eugenics by itself isn't a bad thing, it's how it's implemented.

I have a genetic condition that causes me intense chronic pain and makes me walk with a stick. I think there's an incredibly fine line to walk - for example, where would autistic people fall? Who decides whether ASD is enough of a life-ruiner to edit it out of someone? Who can we trust to hand those reins to?

It’s because a group of people online has chosen this exact subject to go almost quasi-religious on and refuses to accept any debate on the matter or any dissenting opinions. The backlash in itself is pretty confined to these people, so far so social media, but for some reason the media and organisations have chosen to amplify these voices. What is very odd is how wholesale businesses, government organisations, left wing media outlets and NGOs have all embraced the pro-trans message wholesale and are repeating it without any real critique across their areas of influence and punishing people that don’t tow the line. That’s what’s different to other weird internet sub-cultures that failed to blow up in the same way.

I genuinely find it so baffling that anyone can seriously blame online activists for turning this into a divisive subject when our actual prime minister openly mocks the very idea of discussing gender in anything other than completely black and white terms, and our newspapers print virtually daily stories which act as though trans people are the greatest threat facing our country.

Because critique of gender ideals and wanting to live life and be treated the same way whether you dress a certain way or sleep with certain people is not a ‘weird internet subculture’. If you can’t engage with the debate on its level, that’s a shame, but maybe try not to trivialise eh.

I think that would've been fair to say 20 years ago - I remember learning about the sex gender distinction in the 1990s at college. The class I was in included as a key lesson the mistakes people like John Money made in considering gender to be purely learned or social - or as a series of learned stereotypes about male and female, as some would have it. So he tested that theory by raising a boy (who had his genitals mutilated as part of a circumcision gone wrong) as a girl. That belief had awful consequences for his patient, who killed himself. So psychology / psychiatry / medicine moved to a model where we started listening to people when they said they felt like a boy or a girl or what have you. But gender reassignment was in its infancy - we made trans people live as their desired gender for two years before we gave them any physical help whatsoever, which led to awful things happening. And even when they got the help, it was often quite crude, especially if they transitioned later in life. But now we have not only studies, but [studies of studies](https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/), which show the undisputed efficacy of modern gender reassignment as a treatment for gender dysphoria. Do we get everything right? Absolutely not. Did places like GIDS let their patients down terribly? Absolutely - not just the detransitioners, but the trans kids too. So is there serious work required to ensure we NEVER misdiagnose a person with other issues as gender incongruence? Absolutely. But if the diagnosis is done correctly, the efficacy is off the charts. Knee surgery has a higher regret rate. Tonsillectomies have a higher regret rate. The efficacy - and therefore the validity of the sex gender distinction - is settled science at this point. It's the social side of things, and to an extent safeguarding, that's lagging behind.

>But if the diagnosis is done correctly, the efficacy is off the charts.  Isn't that a self-fulfilling prophecy, though? As in, if we only count the people for whom the treatment worked as those where we diagnosed the problem correctly, doesn't that almost by definition massively skew the analysis of whether these treatments work? I'd be very wary of selection and confirmation bias in such a politically loaded setting.

What they mean is that if rigorous and proper medical procedure is followed - which it is the vast majority of the time - gender transition is an overwhelmingly successful treatment for gender dysphoria. It’s the same as any other treatment for any other condition.

We have effective treatments, but are we closer to understanding what events or conditions result in a person needing treatment?

There are some interesting theories, and some [very promising studies](https://en.wikipedia.org/wiki/Causes_of_gender_incongruence#General), but nothing concrete enough for me to tell you we knew precisely why some people are trans and others aren't. However I think your premise (if I've understood it correctly) is flawed. It's not **necessary** to understand the cause to provide an effective treatment. I might not know what caused you to break your leg, but that wouldn't stop me from treating it. We don't even understand why many treatments work - we don't understand how paracetamol works, for example - but we know that it does because the evidence shows it does, and it's one of the safest and most widely consumed drugs we have. As long as the data is solid, we can be very confident about its efficacy. By comparison to paracetamol, gender reassignment is incredibly unmysterious as a treatment!

I agree with you generally, but would argue that it *is* important to understand the cause, on numerous counts: - to use your example, if you broke a leg and the doctor didn't know the cause they would surely explore the cause as legs do not break for no reason - to help society (and particularly those who have taken a political standpoint against gender ideology) understand more about the experience - to make it more relatable - so that we can be more informed when we help trans people themselves I think we would need to be very careful not to frame causation as something that needs to be fixed though - it would need to be a holistic approach aiming to increase understanding rather than highlight something that needs to change.

Sure, philosophically it's important to understand causes. But we're talking about medicinal efficacy here. Doctors cure people. If they understand the cause, great, but it's not necessary for treatment to be efficacious.

>But if the diagnosis is done correctly, the efficacy is off the charts. Knee surgery has a higher regret rate. Tonsillectomies have a higher regret rate. The efficacy - and therefore the validity of the sex gender distinction - is settled science at this point. I'm sorry, but no. Just, no. There is no way that you can look at these rates of regret studies and take the results seriously. If the rates of regret for surgeries in general, including life saving ones, are floating in the mids of 3-11%, and the trans ones are coming in at less than 1%, it can only mean that those studies were not carried out in a trustworthy manner. Before these trans positive studies emerged, the absolute lowest number that could be found was for post malsectomy breast cancer patients have breast reconstruction, and even that only amounted to 14-21% We know that many of these 'trans surgery has no regrets' studies have completely failed to follow up on patients, only examining patients for 6 to 12 months after surgery, and then losing track of the individuals. Another flawed methodology which I came across saw the definition of regret as 'reversal'. Which is not remotely the same thing whatsoever. One study was just a self reported follow up with doctors who perform trans surgeries. (!) Are we supposed to believe the people profiteering from this are going to cast aspersions on their own work? Or that any cases that have gone wrong, through either regret or complication, are still in touch with these doctors? By all means, include these studies and discuss them rationally, but don't try to sell the incredibly inadequate, often nonsensical conclusions as 'settled science'

>If the rates of regret for surgeries in general, including life saving ones, are floating in the mids of 3-11%, and the trans ones are coming in at less than 1%, it can only mean that those studies were not carried out in a trustworthy manner. An alternative hypothesis I would suggest that is transgender surgery is very hard to get, so historically only the most anguished of patients actually went for it. And the pain of severe gender dysphoria along with its relief is much more immediate that something as abstract as "there is something in you that could be invisible, that may kill you later". For example as best I can tell the process for getting a breast reconstruction on the NHS is a GP referral and then a consultation with a surgeon. The process for getting a gender reassignment on the NHS is a GP referral, then a consultation with a psychologist, then a consultation with another medical professional who is usually a GP with a specialism in gender care, then a year or two on hormones, then another consultation with another psychologist, and then a consultation with a surgeon. So you can probably imagine that attrition plays some part in who gets these surgeries and subsequent regret rates. >One study was just a self reported follow up with doctors who perform trans surgeries. (!) Are we supposed to believe the people profiteering from this are going to cast aspersions on their own work? Or that any cases that have gone wrong, through either regret or complication, are still in touch with these doctors? There's also huge lobbies that are dedicated to trying to disprove the surgery altogether. Are we supposed to believe that patients that had it go wrong just disappeared off the face of the Earth, never talked to their doctor ever again and somehow never ended up being discovered by the anti-surgery crowd?

>If the rates of regret for surgeries in general, including life saving ones, are floating in the mids of 3-11%, and the trans ones are coming in at less than 1%, it can only mean that those studies were not carried out in a trustworthy manner. That's an astonishing charge. I can think of a tonne of reasons why gender reassignment might have such low regret rates compared to things like hip surgery (6%-30% regret rate, mastectomy reconstruction (47% regret rate), prostate surgery (20%), or knee replacement (10%). The most obvious is that with other forms of surgery, the best that can happen is you get halfway back to normal - you'll very rarely finish feeling better than you did before you got sick. But with gender reassignment, you might actually make your patient happy - they may finish feeling happier, stronger, more themselves than they did beforehand. That's very rare for surgery. It might also be that gender reassignment is carried out on the young, by and large, who are more able to recover from surgery. It might also be that as a newish treatment, Drs are more careful about setting the right expectations with their patients for post surgery care. It might be that getting gender reassignment is so difficult that only those who feel the most acute symptoms (and therefore the most acute relief) get it. The ONLY way we find out will be through interrogating the data (and you're welcome to point out your methodological concerns with studies of peer reviewed studies like these: [https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people](https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people) and [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405) ). You know how we WON'T find out? By assuming any data that contradicts your own views must've been 'carried out in an untrustworthy manner'. Without any evidence whatsoever. You strike me as being someone who understands data and argument. If so, you let yourself down there.

I do wonder if people think the same way about gay people. You can argue both are brain-issues, so what, will we also treat gay people badly again? It seems weird that apparently people draw the lines at trans. And I say that as a gay person.

This is a question for the health service of is there any alternative to highly invasive surgery and/or drugs with severe side effects that would result in trans patients being happy. There's really no equivalent issue for gay people.

Although being gay doesn't mean you have to physically change who you are.

It's impossible to do research on the subject.

I feel like I'm supposed to have a 12" dick but I don't. Alas I have to accept what I was given.

Breaking news, children seeking a diagnosis of gender dysphoria, which commonly causes depression, may in fact have gender dysphoria and depression. Yesterday's weather forecast at six.

Extensive study finds obvious thing is obvious.

No shit really. Your mind and body are not in sync.

Yes, because *of course they do.* Because anyone would, if they had to grow up in the wrong body with nobody to relate to, very little help available (and it's reducing all the time!), new rules that say your school doesn't have to use your chosen name or pronouns, a life of stigma and danger and fear ahead of you, and everyone writes you off as ~mental~. Literally just think about the word "dysphoria": > borrowed from Greek *dysphoría* "malaise, discomfort, vexation," from *dýsphoros* "hard to bear, grievous" [(source)](https://www.merriam-webster.com/dictionary/dysphoria) "Oh, hi, I have *unbearable gender,* but other than that I'm doing fine, thanks for asking! 🥳🥳🥳" Also, a reminder that ***fewer than 100 children*** are currently receiving puberty blockers on the NHS in England, which is ***0.00017% of the population.*** But yes absolutely, let's focus on those people and how mentally unwell they are, it's not like there's anything else going on. 💀

THANK YOU. To those going through it and their parents/guardians, this is a huge thing. But to the rest of the population, objectively speaking, it affects such an insanely small fraction of people that the very fact we are constantly bombarded with news and asinine public debates about it is a fucking farce! Most extreme example of this - Trans athletes. “Oh my god who the fuck cares” should be the only response needed from 99.999999999% of the population.

"the wrong body" always makes me roll my eyes a little. You don't get to choose your body.

Haha exactly, is it wrong body or wrong mind. Body = 1 - Mind We should start focusing research on treating the cause of the mental issue and not the symptom of it.

So the report isn't out, and the telegraph don't know what's in it, but They're saying what they expect is in it? Is this typical journalism?

They are sadly probably right. The committee specifically excluded trans people from having input whilst encouraging people who have no relation to healthcare whose only notoriety is for being fired for transphobia.

I know a number of trans people, either friends, colleagues or friends of my wife. Without being too simplistic they all tick the same two boxes. - Are gay taking in to account their biological sex. - Have a history of mental health problems such as depression or anxiety.

Indeed. Thinking in terms of my friends (who I do greatly respect and will gladly use whatever pronouns they want) they're almost all autistic.

I work for a mental health team and I can assure you that there are an awful lot of young people who are viewed as having mental health issues (anxiety, depression) when the issue is not a mental health issue and due to this most people tick the last box.

Gender dysphoria does cause a lot of mental anguish, yes. As does the bullying they receive.

> Counselling to tackle issues holistically > It is expected to suggest that these children need counselling to tackle these issues holistically, rather than them automatically being put on a path to change gender Be sure to ask for this at the end of your 6-year wait for treatment, kids.

Well obviously? Isn't it mental condition of some sort? Sadly some seem to prioritise the "identity" aspect rather trying to deal with the condition itself

The issue is that we cannot currently change the identity of one's brain, what you feel you are. People have tried, and it doesn't work, drugs, conversion therapy, electric shocks, torture, none of those methods change what the brain thinks it is. What we can do is treat the symptoms of gender dysphoria, with hormonal therapy, affirming surgery, name and pronoun changes, etc. These methods have demonstrated great results in reducing the feelings of gender dysphoria amongst patients, and as a side effect, often result in the alleviation of depression.

[A Dutch study has also recently found that close to two thirds of children who express gender confusion will "grow out" of it.](https://www.washingtontimes.com/news/2024/apr/8/most-kids-grow-out-gender-confusion-long-term-dutc/) > The newly published research in the Archives of Sexual Behavior tracking 2,772 adolescents into early adulthood said that 11% reported “gender non-contentedness” at age 11, a figure that decreased with age and fell to 4% by ages 24-26. So while it's clearly not the case that wanting to transition is itself entirely down to mental health issues, I'm prepared to believe mental health issues can play a major part. Though I've never been comfortable with offering this stuff to children. Conventional wisdom was always that children were too young and immature to take all sorts of major life-altering decisions, but that somehow never applied to transitioning. So you might say I'm biased in this but I am actually glad that there's been a rowing-back lately about how accessible transitioning is to children.

Despite the reporting, that isn't actually a study on trans kids. It's a study of kids in general and asks 11 year olds if they feel content in their body. It is not surprising that many said no, given that puberty is a hard time for a lot of people. from the study: >Also, in our study, no data on gender identity were available, but in the current, eighth assessment wave of TRAILS information on participants’ gender identity is being collected. Future studies may therefore investigate whether those participants who experienced gender non-contentedness in adolescence identified as transgender in adulthood.

Although, that is a really important thing to look at. When you have trans right groups advocating for puberty blockers at an early age it sort of proves that this is completely the wrong approach and most children need support and guidance

Problem is if you deny trans people puberty blockers at an early age you’re kind of fucking them over for the rest of their life. Just because we (who are completely separate from this) are uncomfortable with them having them.

I think you need to read further into that. Delaying or stopping the natural puberty is inherently very dangerous. I would be careful going down this path.

>It's a study of kids in general and asks 11 year olds if they feel content in their body. No, they were asked about wanting to be the opposite sex. >The study divided children into three trajectories based on their response to the statement, “I wish to be of the opposite sex.” The participants had three options: “never,” “sometimes,” or “often.”

This isn’t a study of trans-identifying children, though.

> So you might say I'm biased in this but I am actually glad that there's been a rowing-back lately about how accessible transitioning is to children. Maybe if the numbers being treated or seen by the services gets anywhere close to 4% we can start talking about rowing back accessibility.

Transitioning isn’t readily accessible to children though.

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No shit, I’d have mental health issues if I had to deal with the stigma

The exhausting part is that it's now basically impossible to interact with any form of social or traditional media, or often the internet in general, without seeing articles like this on an almost daily basis, and you don't need to read it to be reminded of what the comments section will look like. I have carefully curated content to avoid this as far as possible but even then it's not uncommon to find someone who wants to shove their pet peeve into the discussion of something completely unrelated - I watched a YouTube video about medieval execution methods, figured it was probably safe to read the comments on that, and somebody had still felt the need to add "well at least they knew what a woman was."

It’s a nightmare, I’m not even trans and it annoys me that there’s no escaping them.

Yeah, obviously children who are constantly mocked and treated like filth might have mental health issues But the reasonable response to that is "and therefore we should help them", not "and therefore we should refuse to listen to anything they say"

Politely as a trans person I do not understand the issue about trans people existing. All I want to do is play videogames, watch movies, hang out with my friends, and take my hormones. I don't get why we're a huge political flashpoint.

The most alarming thing is that we encourage it and parade it as if it should be worn like some sort of trophy.

No shit Sherlock, thats call gender dysphoria

Genuine curious question; why would a literal child even be thinking about doing this? Surely they’re too young to understand, and what exactly brings them to this conclusion anyway? There’s a little boy on my estate that must be about 5 and he’s regularly dressed like a female goth with a skirt, tights etc. He sometimes goes all out and kinda looks like a hooker, it’s really strange. I just don’t get it, I’m not saying he can’t wear what he wants but why? What possessed him to feel the need to do this? He’s too young

Huh, so calling people a bigot for no reason and trying to prevent anyone from disagreeing with you isnt stopping people questioning all of that. A significant % of the reddit mod staff must be pissed.

God, I hate headlines like this. I could do another report and get the headline "Children who don't want to change gender may have mental health issues, report warns." And both are true at face value. They both may have mental health issues.

I mean yeah... especially when you take all treatment options away... I mean... What the fuck did they expect? "Children who are suicidal may be depressed"

I believe that the mental health issues are very much linked to the gender dysphoria and transphobia issues

Well... Yeah? Gender dysphoria is a mental health issue that is treated by transitioning.

So much Torygraph ragebait posting recently, eurgh

I believe the whole trans debate has become an issue because of the way americans do health care. Doctors are happy to push medical solutions that come with expensive surgeries and lifelong drug dependence. Way more profitable than some therapy sessions with a competent practitioner. I, for one, have never met anybody who knew themselves at 12 or even 22. People are too quick to slap on a label these days.